To evaluate the successful revascularization in patients with internal carotid artery occlusion (ICAO) after carotid endarterectomy (CEA), arterial embolectomy (CEA & AEmb) or CEA and stent implantation (CEA & Stent) using color doppler flow imaging (CDFI) and transcranial color-coded sonography (TCCS).

From January 2007 to January 2018, a total of 78 patients with ICAO confirmed by DSA and treated with CEA & AEmb or CEA & Stent were included in this study. CDFI and TCCS were completed in a week before and after surgery. The influence factor for success of recanalization were recorded and analyzed, such as diameters proximal and distal to the internal carotid artery (ICA), echo characteristics in the lumen of ICA, length of the plaque and thrombus, collateral circulation established (The blood flow of the ophthalmic artery reversed).

The rate of complete recanalization was 78.2% (61/78), while 17 patients were failed (15 had occlusion and 2 had severe residual stenosis). The incidence of perioperative complications was 6.4%. Multiple logistic regression analysis showed that homogeneous echo intra-ICA (OR=0.069, 95%CI: 0.045~0.604, P=0.007) and flow reversal of the ophthalmic artery (OR=0.164, 95%CI: 0.009~0.501, P=0.008) were independent influence factors for recanalization rate. There was no significant difference in the effect on the rate of recanalization between the proximal and distal to ICA diameter (P=0.078).

The echogenicity intra lumen of ICAO and the reversed direction of the ophthalmic artery are closely related to the rate of recanalization. It is of the great predictive value to evaluate the success of ICAO combined CDFI with TCCS.